Trichuris trichiura

Characteristics
Morphology	Trichuris trichiura (whipworm), causative agent of Trichuriasis, is considered as a Neglected Tropical Disease and the second most common helminth in humans. The prevalence is higher in places with warm and humid weather, where there is a lack of basic sanitation services. Between 30 and 80% of cases are recorded in children, who suffer the greatest parasitic burden and those with the most significant symptoms. The adult worms (approximately 4 cm in length) live in the cecum and ascending colon of infected individuals and can live for up to a year.
Growth Conditions	Schistosoma develops in snails and upon leaving them in their adult form (Cercariae) infect people who are in bodies of fresh water where the snails live

Characteristics

Morphology

Trichuris trichiura (whipworm), causative agent of Trichuriasis, is considered as a Neglected Tropical Disease and the second most common helminth in humans. The prevalence is higher in places with warm and humid weather, where there is a lack of basic sanitation services. Between 30 and 80% of cases are recorded in children, who suffer the greatest parasitic burden and those with the most significant symptoms. The adult worms (approximately 4 cm in length) live in the cecum and ascending colon of infected individuals and can live for up to a year.

Growth
Conditions

Schistosoma develops in snails and upon leaving them in their adult form (Cercariae) infect people who are in bodies of fresh water where the snails live

Health Hazards
Host Range	Humans, chimpanzees, pigs, lemurs, and monkeys
Modes of Transmission	Transmission of this parasite occurs after ingestion of embryonated eggs. These eggs can enter new hosts through contaminated hands, food, soil, and water. Then these hatch in the intestine, where L1 larvae are released. Larvae penetrate the epithelial layer of the large intestine and grow to adult stage. After mating, the non-embryonated eggs are released from the females and again reach the environment through the host's feces.
Signs and Symptoms	Cases of trichuriasis tend to vary in manifestation and can be dependent on the severity of the infection. Individuals with light infections usually have no symptoms, with some resulting in peripheral blood eosinophilia. Individuals with moderate to severe infections may develop symptoms such as frequent, painful and/or bloody stool, rectal prolapse, or anemia. Children with prolonged or severe anemia may develop significant growth or mental impairment.
Infectious Dose	Unknown
Incubation Period	Unknown, but the period from egg ingestion to egg production is reported to occur within three months

Medical Precautions/Treatment
Prophylaxis	Anthelminthic medications can be used for prevention, but the best methods to reduce infection chance are to promote hand washing and avoid ingesting contaminated food or soil.
Vaccines	None readily available
Treatment	Anthelminthic medications are readily available. Iron supplements may also be prescribed if the infected person suffers from anemia.
Surveillance	Monitor for symptoms. Confirm through identifying whipworm eggs in a stool sample or presence of T. trichiura adult parasites within the large intestine by colonoscopy.
GWU Requirements	Report all incidents to the Office of Risk Management as well as the Office of Research Safety (ORS) IMMEDIATELY FOLLOWING THE OCCURRENCE.

Containment
BSL-2/ABSL-2	Risk Group 2 classification is applied the parasite. BSL-2 and ABSL-2 practices, including appropriate PPE and containment equipment/facilities, are recommended for laboratory work with infective stages of the parasites discussed here (i.e. embryonated egg samples)

Spill Procedures
Small Spills (<1 liter)	If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup. T. trichiura is not known to be transmitted via aerosols, but caution should be taken during a spill outside of a BSC. Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against the parasite (bleach, ethanol, glutaraldehyde), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.
Large Spills	Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Spill Procedures

Small Spills (<1 liter)

If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup.

T. trichiura is not known to be transmitted via aerosols, but caution should be taken during a spill outside of a BSC. Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against the parasite (bleach, ethanol, glutaraldehyde), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.

Large Spills

Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Exposure Procedures
Mucus Membrane	Flush eyes, mouth or nose for 15 minutes at eyewash station.
Other Exposure	For an area not protected by skin, wash with soap and water for 15 minutes (open wounds, sores, etc.).
Reporting	Report ALL injuries to the PI immediately and reported to the Office of Risk Management at [email protected] IMMEDIATELY FOLLOWING THE OCCURRENCE. Exposures that involve a bloodborne-pathogen or recombinant DNA also need to be reported to the Office of Research Safety at [email protected]. If the injury requires immediate medical attention, call GWPD at 202-994-6111 or call 911.
Medical Monitoring	Seek immediate medical evaluation, treatment, and post exposure follow-up at the Employee Health Office at GWU Hospital (900 23rd St., NW, Suite G-1090, Phone: 202-715-4275). Students should go to the Students Health Office at Marvin Center. After hours treatment can be received at the GWU hospital emergency room.

Stability
Disinfection	30% ammonia in combination with temperatures above 30°C is documented to inactivate eggs
Inactivation	T. trichiura eggs are sensitive to sunlight and will perish below -9°C and above 52°C.
Survival Outside Host	T. trichiura eggs will survive in soil for around 2 weeks.

Personal Protective Equipment (PPE)
Minimum PPE Requirements	At minimum, personnel are required to don gloves, closed toed shoes, lab coat, and appropriate face and eye protection prior to working with T. trichiura. Additional PPE may be required depending on lab specific SOPs.
Additional Precautions	Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, gloves, and respiratory protection. Wash hands with soap and water after removing gloves.

References
CDC (https://www.cdc.gov/parasites/whipworm/) BMBL 6th Edition (https://www.cdc.gov/labs/BMBL.html) Canadian PHAC (https://www.canada.ca/en/public-health/services/laboratory-biosafety-bi…) Texas Department of State Health Services (https://dshs.texas.gov/IDCU/disease/Trichuriasis.aspx) ABSA (https://my.absa.org/riskgroups) Trichuris trichiura (Linnaeus, 1771) From Human and Non-human Primates (https://www.frontiersin.org/articles/10.3389/fvets.2020.626120/full)

References

CDC (https://www.cdc.gov/parasites/whipworm/)

BMBL 6th Edition (https://www.cdc.gov/labs/BMBL.html)

Canadian PHAC (https://www.canada.ca/en/public-health/services/laboratory-biosafety-bi…)

Texas Department of State Health Services (https://dshs.texas.gov/IDCU/disease/Trichuriasis.aspx)

ABSA (https://my.absa.org/riskgroups)

Trichuris trichiura (Linnaeus, 1771) From Human and Non-human Primates (https://www.frontiersin.org/articles/10.3389/fvets.2020.626120/full)